You are here

Archived: Drs Bilas & Thomas Good

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 20 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Bilas & Thomas on 20 June 2016. After the comprehensive inspection, the practice was rated as requires improvement for providing safe services.

We issued a requirement notice in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drs Bilas & Thomas on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 20 June 2016. This report covers our findings in relation to those requirements.

Our key findings were as follows:

  • The recording of significant events had been reviewed and were sufficiently detailed to show that concerns identified about patients were appropriately followed up to prevent further occurrences and ensure improvements made were appropriate.
  • The practice had reviewed its systems and procedures to ensure the safe management of medicines.
  • Records were available to confirm that a full legionella risk assessment had been carried out.
  • The practice’s complaint handling procedures had been reviewed to ensure that the appropriate management of verbal complaints was included. Staff were made aware of the procedure to follow.
  • The practice chaperone practices had been reviewed to ensure that all staff were aware of the correct procedure to follow when carrying out the role.
  • Staff had received training to ensure that they were aware of the requirements of the Mental Capacity Act (MCA) 2005 and their responsibilities under the act as it relates to their role.

There was one area where the provider should make improvements:

  • Ensure that a risk assessment is completed to determine whether there is a need for a second thermometer to confirm the accuracy of the temperature of the fridge used to store medicines.

At this inspection we found that the practice had addressed all the concerns raised and is now rated as good for providing safe services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 July 2017

The practice is rated as good for providing safe services:

  • There was an effective system in place for reporting and recording significant events.

  • Records of clinical and significant event meetings demonstrated that incidents were discussed and appropriate systems put in place to monitor that action taken was appropriate.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, relevant information and an apology. Patients were told about any actions to improve processes to prevent the same thing happening again.

  • Risks to patients were assessed and well managed. For example, the practice had ensured that:

    • A full legionella risk assessment was carried out at the practice.

    • The management of medicines had been reviewed and changes made to ensure safe practices were implemented.

Effective

Good

Updated 23 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that the overall achievement of 85% of the available points was below average when compared to the locality average of 92% and the national average of 95%. The practice had taken action to improve clinical outcomes for patients.
  • Staff assessed patient needs and delivered care in line with current evidence based guidance.
  • The practice had completed clinical audits and the outcomes used to monitor quality and make improvements.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. There was evidence of staff appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. For example, the practice held meeting with the professionals involved in the care of patients receiving palliative care.
  • Arrangements were in place to gain patients’ informed consent to their care and treatment.
  • Patients were supported to access services to promote them living healthier lives.

Caring

Good

Updated 23 September 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey results published in January 2016 showed patients rated the practice similar to others for most aspects of care.
  • Patients were treated with dignity and respect and they were involved in decisions about their care and treatment. Systems were in place to protect patient confidentiality.
  • Arrangements were in place to ensure that patients and carers received appropriate and effective support.

Responsive

Good

Updated 23 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice worked closely with secondary care professionals on initiatives to improve the care of patients with COPD.
  • Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day. The practice did not offer extended hours or telephone appointments to patients who worked.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff. A log of written and verbal complaints was not maintained to demonstrate any trends.

Well-led

Good

Updated 23 September 2016

The practice is rated as good for being well-led.

  • The practice had a vision to deliver high quality care and promote good outcomes for patients. Staff were aware of the vision and their responsibilities in relation to this.
  • There was a clear leadership structure and staff felt supported by the management.
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • Arrangements for identifying, recording and managing risks and implementing mitigating actions did not cover all areas to ensure that patients and staff were protected from the risk of harm at all times. This included for example, arrangements for the safe management of medicines.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The GP partners encouraged a culture of openness and honesty.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was limited evidence to demonstrate that the practice had a strong focus on learning. For example we found that insufficient information had been provided following significant events and clinical audits to demonstrate that learning was shared with all staff.
Checks on specific services

People with long term conditions

Good

Updated 23 September 2016

The practice is rated as good for the care of people with long-term conditions.

  • The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was similar to or higher than the local and national average. For example the practice performance for diabetes related clinical indicators was higher than the local Clinical Commissioning Group and England average (94% compared to the local average of 82% and England average of 89%).
  • Longer appointments were available when needed and home visits made to patients who were housebound.
  • The named GP and practice nurse worked with relevant healthcare professionals to deliver a multidisciplinary package of care to patients with complex needs.

Families, children and young people

Good

Updated 23 September 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who did not attend hospital appointments.
  • Immunisation rates for standard childhood immunisations were similar to or higher than the local CCG immunisation rates.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered some contraceptive services and in the absence of a female GP offered female patients the choice of referral to local family planning services. Patients were referred locally for specialised contraceptive services.
  • The practice’s uptake for the cervical screening programme was 83%, which was comparable to the national average of 82%.

Older people

Good

Updated 23 September 2016

The practice is rated as good for the care of older people.

  • The practice offered personalised care to meet the needs of the older people in its population.
  • The practice offered home visits to older people who were housebound only.
  • Flexible appointments were available for older patients.
  • All patients aged 75 plus were offered a health check including blood tests.
  • Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

Working age people (including those recently retired and students)

Good

Updated 23 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice did not offer extended opening hours and the appointment telephone line was not easily accessible to patients who worked during the day.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
  • University students were offered the options of re-registering with the practice as a temporary resident or as a patient in immediate need of treatment.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
  • The practice held a register of patients who experienced poor mental health. Clinical data for the year 2014/15 showed that 67% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This was much lower than the national average of 88%.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Counselling clinic sessions were held at the practice with an experienced mental health counsellor based in the community.
  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 75%, which was lower than the national average of 84%.
  • The practice maintained a register of patients diagnosed with dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients with a learning disability and had plans in place to ensure annual health checks were carried out for these patients.
  • The practice had a low prevalence of patients living in vulnerable circumstances, when identified the practice assisted and supported these patients on an individual basis.
  • Staff had been trained to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.